Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension

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Abstract

BACKGROUND—: Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis as compared to idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. METHODS AND RESULTS—: RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; p=0.039). At matched exercise (25 Watts), SSc-PAH patients failed to augment contractility (end-systolic elastance) whereas IPAH did (p

Original languageEnglish (US)
JournalCirculation
DOIs
StateAccepted/In press - May 12 2016

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Pulmonary Hypertension
Ergometry
Right Ventricular Function
Systemic Scleroderma
Recycling
Ventricular Pressure
Blood Vessels
Heart Rate
Exercise
Calcium
Lung

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{69a5228ffc834cb7a039dd7b3fc9099d,
title = "Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension",
abstract = "BACKGROUND—: Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis as compared to idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. METHODS AND RESULTS—: RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; p=0.039). At matched exercise (25 Watts), SSc-PAH patients failed to augment contractility (end-systolic elastance) whereas IPAH did (p",
author = "Steven Hsu and Houston, {Brian A.} and Emmanouil Tampakakis and Bacher, {Anita C.} and Rhodes, {Parker S.} and Stephen Mathai and Damico, {Rachel L} and Kolb, {Todd Matthew} and Laura Hummers and Ami Shah and Zsuzsanna McMahan and {Corona Villalobos}, Celia and Stefan Zimmerman and Fredrick Wigley and Hassoun, {Paul M} and Kass, {David A} and Tedford, {Ryan J.}",
year = "2016",
month = "5",
day = "12",
doi = "10.1161/CIRCULATIONAHA.116.022082",
language = "English (US)",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",

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T1 - Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension

AU - Hsu, Steven

AU - Houston, Brian A.

AU - Tampakakis, Emmanouil

AU - Bacher, Anita C.

AU - Rhodes, Parker S.

AU - Mathai, Stephen

AU - Damico, Rachel L

AU - Kolb, Todd Matthew

AU - Hummers, Laura

AU - Shah, Ami

AU - McMahan, Zsuzsanna

AU - Corona Villalobos, Celia

AU - Zimmerman, Stefan

AU - Wigley, Fredrick

AU - Hassoun, Paul M

AU - Kass, David A

AU - Tedford, Ryan J.

PY - 2016/5/12

Y1 - 2016/5/12

N2 - BACKGROUND—: Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis as compared to idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. METHODS AND RESULTS—: RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; p=0.039). At matched exercise (25 Watts), SSc-PAH patients failed to augment contractility (end-systolic elastance) whereas IPAH did (p

AB - BACKGROUND—: Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis as compared to idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. METHODS AND RESULTS—: RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; p=0.039). At matched exercise (25 Watts), SSc-PAH patients failed to augment contractility (end-systolic elastance) whereas IPAH did (p

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